Overview and specific aims: Organizational culture may be defined as the values, beliefs, and norms of an organization that shape its behavior. In health care, organizational culture has been identified as an important enabling factor in implementing continuous quality improvement and total quality management and in promoting integration in health care systems. The pressing need to increase the reliability of health care systems to reduce frequency of adverse events--both negligent and other types--has placed a renewed focus on the role of organizational culture in promoting patient safety. The specific aims of the project are: (1) To adopt existing instruments that measure organizational culture in the study of attitudes, behaviors, and practices about patient safety in the health care organizations of an integrated delivery system. (2) To adapt instruments that assess the implementation of quality improvement in health care settings to the assessment of attitudes, practices, and behaviors about patient safety. (3) To establish the psychometric properties of the instruments that are developed (internal validation). (4) To describe the organizational culture of the constituent facilities in an integrated delivery system using existing instruments that assess organizational culture. (5) To describe the attitudes, practices, and behaviors about patient safety in the health care organizations of an integrated delivery system. (6) To assess the association of organizational culture with attitudes, practices, and behaviors about patient safety within these health care organizations. Research plan: (1) Adapt an existing survey about the implementation of quality improvement in health care settings to the assessment of attitudes, beliefs, and behaviors about patient safety. (2) Establish the psychometric properties of the resulting instruments (internal validation) with a survey of 1,200 individuals in the Partners HealthCare System. (3) Describe the organizational culture and the attitudes, beliefs, and behaviors about patient safety by conducting a cross-sectional observational study of 5,000 staff of Partners HealthCare System stratified by work environment. (4) Assess the association of organizational culture with attitudes, beliefs, and behaviors about patient safety; and test the hypothesis that organizational culture (group/development type) will be associated with staff attitudes, behaviors, and practices that promote patient safety. Correlation and multivariate analysis will be used to describe the associations between staff perceptions of organizational culture and attitudes, behaviors, and practices about patient safety.